Transjugular intrahepatic portosystemic shunt (TIPS) is a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein. This is an important addition to the therapeutic armamentarium against portal hypertension. Complications are either technical or due to the creation of a shunt. Procedure-related mortality is about 0 to 2%. Cardiac perforation, one of the rarest complications during TIPS, can occur while traversing the catheter from the jugular vein past the right atrium to enter the hepatic vein. We are reporting the case of a 50-year-old woman who became acutely hypotensive with cardiovascular compromise during the TIPS procedure. A stat echocardiogram confirmed cardiac tamponade and emergency pericardiocentesis resulted in improvement of hemodynamic status with complete recovery.